1. Field of the Invention
This invention relates generally to education of medical professionals using medical simulators, more specifically to a method and apparatus for integrating simulator data from multiple medical simulators.
2. Background Information
I. Medical Simulator Background
While it is desirable to train students in patient care protocols and proper use of specific medical devices before allowing contact with real patients, textbooks and flash cards lack the important benefit to students attained from “hands-on” practice. However, the training of medical personnel in the art of gynecological techniques or child-birthing, for example, is hampered by the unavailability of live patients willing to be practiced on and the undesirability of allowing untrained personnel from performing life affecting, and possibly threatening, medical procedures.
Thus, patient care education has, in recent years, often been taught using devices, such as a manikin configured to simulate a patient, commonly called “medical simulators”, “patient simulators”, and “patient mannequins”, and “robotic patients” as well as simply “simulators” and “mannequins” (in context).
Within the meaning of this application the terms “medical simulators”, “patient simulators”, and “patient mannequins”, and “robotic patients” as well as simply “simulators” and “mannequins” will reference a narrower subset of these devices that have at least one time based electronic signal as an output of the ongoing medical simulation. Typically, the electronic signal(s) from such simulators will be indicative of the simulated physiologic parameters of the “patient,” during the training, such as the simulated heart rate, breath rate, body temperature, blood oxygenation, or any desired simulated physiologic parameter that is deemed useful for the procedure and for review of the procedure. These electronic signals can further include a video recording of the training session, an audio recording of the session, or ambient measurements, such as recording of ambient temperatures during the session. Again, within the meaning of this application a “simulator” must include at least one such electronic signal.
The presently available patient simulator mannequins provide “hands-on” training to medical personnel in areas such as trauma treatment, anesthesiology, gynecological examination, childbirth, and a host of other medical simulator specific procedures. These mannequins typically have significant physiologic mimicking capabilities. Various medical devices can be attached to these mannequins to train users in the proper implementation and use. These mannequins are typically computer controlled and are programmed for a variety of responses which simulate medical conditions.
Using patient simulator mannequins, the students, nurses, medical personnel, etc. can learn medical protocols and develop skills in manual dexterity and proper placement of leads, tubes, etc. without risk. One approach to the use of patient mannequins was taken in U.S. Pat. No. 5,853,292 which discloses using sensor-equipped “virtual” instruments interfaced with a patient simulator through a computer interface module. U.S. Pat. No. 6,535,714 relates to medical device training including providing for documentation of competency during the training exercise. This patent is incorporated herein by reference. U.S. Pat. No. 6,428,323 discloses a system for teaching students and health care professionals medical examinations performed manually inside a body cavity or anatomical space. This patent is incorporated herein by reference. U.S. Pat. No. 4,360,345, which is incorporated herein by reference, discloses a further simulator system for teaching cardiopulmonary resuscitation (CPR) and other basic physiological procedures.
As a further representative example, one gynecological medical simulator, known as ZOE™ brand product, is disclosed in U.S. Pat. No. 5,472,345. U.S. Pat. No. 7,465,168 owned by Birth Injury Prevention, LLC of Baltimore, Md. discloses a birthing simulator. Birthing is one physiological process that is useful to simulate. For instance, while the birthing process itself is a natural process that often concludes without complications, even in an uncomplicated birth, obstetric procedure can cause injury to the fetus and the mother. Moreover, while many births occur without complications, some births do not. Of the different types of complications that may occur, a number of them represent potentially life-threatening obstetric emergencies. Birthing simulators allow clinicians and researchers to research and train for complications and obstetric emergencies without risking fetal or maternal injury.
Gaumard Scientific Company, Inc. (Gaumard) of Miami, Fla. has developed a variety of medical simulators that are representative of the state of the art in medical simulators. Gaumard first introduced a basic childbirth simulator in 1949 and have over half a century of experience in the simulator field. The currently available NOELLE™ brand birthing simulator from Gaumard is a pregnant robotic simulator used in increasing numbers of medical schools and hospital maternity wards.
Further medical simulators and related devices described in U.S. Pat. Nos. 7,192,284; 7,114,954; 6,758,676; 6,527,558; 6,503,087; 6,503,087; 6,443,735; 6,193,519; 5,853,292 (discussed above); and U.S. Pat. No. 5,472,345 that are assigned to Gaumard. These patents are incorporated herein by reference.
Other examples of such patient mannequins are disclosed in U.S. Pat. Nos. 5,941,710; 5,900,923; 5,403,192; and 3,520,071, the disclosures of which are incorporated herein by reference.
The SIMMAN™ brand product is a portable and advanced patient simulator for team training in the emergency treatment of patients. The device is from Laerdal Medical, Inc. (Laerdal). The SIMMAN™ patient simulator has a realistic anatomy and clinical functionality and provides simulation-based education through realistic patient care scenarios. Laerdal further provides a PROMPT™ brand birthing simulator.
The Eagle Patient Simulator, developed by David Gaba, MD, and others, at Stanford University, and marketed by MedSim, Inc. of Ft. Lauderdale, Fla., connects to an interface cart that drives the mannequin's electromechanical functions. The cart also serves as the interface for conventional monitoring equipment found in the operating room.
The G. S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program in Medical Simulation is a resource for all Harvard Medical School students and faculty. The Gilbert Program integrated learning labs are each equipped with a realistic mannequin patient simulator, a seminar table with whiteboard, and a web-connected plasma display. This unified learning lab brings together traditional teaching and web-based information technology all at the bedside of a simulated patient. The mission of the G. S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program is to “bring to life” good teaching cases for medical students of all levels using high-fidelity patient simulation to foster experiential learning in a safe environment”
II. Recorded Medical Simulator Sessions
The realism of the patient simulators represents only one portion of the entire educational experience. It is common for the simulation events to be monitored and even recorded, typically on video-tape or via a hand held video recorder, for peer or teacher review. This critical review and feedback of a session is as important a teaching tool as the simulation itself.
In such analysis and feedback of given simulation sessions, the trainees can have mistakes pointed out and corrected. Conventionally this entails that the entire event is recorded on a camera for playback. The recording of the event is particularly useful in simulations where there are multiple participants, i.e. a “team” of participants, that may have overlapping spheres of influence, and the event recording is the only effective review of the team interaction to review how the team worked together. The simulator itself will often have a recording of the changes in all of the particular simulated physiologic parameters of the simulator (i.e. the data output) over the time of the session for latter analysis, whereby there is an objective review of the session on the simulator (e.g., how did the simulated patient do throughout the event).
The data output record of a session does not provide adequate information as to why a particular patient result was achieved in a session, particularly in a team participant environment with overlapping areas of influence relative to the simulated physiologic parameters of the simulator. A video and an audio recording of the event does add the ability to review why a particular result was or was not achieved in a session with the patient simulator.
In 2003, the Peter M. Winter Institute for Simulation, Education and Research (WISER), a simulation center located at the University of Pittsburgh Medical Center (UPMC), attempted to utilize the Laerdal SIMMAN™ Simulator to generate Extensible Markup Language (XML) performance logs of simulation sessions that could then be utilized to correlate with a digital primary video file. The digital video recording was stored on a central server with playback made available over the Internet via a standard web browser. The time stamp on the performance log was attempted to be utilized as an index mechanism for the primary video file. The system never proved to be effective in practice, however, and the attempted integration was not sufficient to be a meaningful tool for students. The proposed system did not offer independent control over various inputs.
KB Port, LLC. (KB Port) of Pittsburgh, Pa. currently provides a system for effectively synchronizing the video, audio recordings and data log files for analysis and for playback (feedback). The KB Port ETC™ brand system can take multiple video and audio input signals and effectively synchronize these with multiple data inputs of medical simulators for integrated playback. The 2008 version of the ETC™ product provides a seamless integration of video and audio and data inputs and it is this system that is particularly helpful in implementing the aspects of the present invention as described below. The operating aspects of the ETC™ product are described in U.S. Patent Publication No. 2008-0124694 which is incorporated herein by reference in its entirity. Within the meaning of this application, the ETC™ system is a type of synchronizing system, wherein a synchronizing system is a system that can receive a variety of independent time based inputs, including audio and visual inputs, for storage and provide for playback of the inputs in an integrated, synchronized manner.
III Multiple Medical Simulators
There are several areas in which multiple medical simulators are utilized and beneficial, or in which the ability to utilize multiple medical simulators would be beneficial. Currently child birthing simulations can occasionally utilize a separate infant simulator. It has been known to progress through a first part of the simulation with the pregnancy simulator then artificially pause the simulation while the infant simulator is brought on-line to continue the session with the infant simulator. This interruption will negate the seamless training aspects of the exercise making it less realistic and thus less practical from a training perspective.
Other areas where the efficient use of multiple simulators is beneficial is in triage scenarios Triage is broadly defines as the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care. Triage is done in emergency rooms particularly in large cities, and in all medical facilities following natural disasters, wars and civil unrest when limited medical resources must be allocated to maximize the number of survivors.
The US Department of Defense defines “triage” as follows: “The evaluation and classification of casualties for purposes of treatment and evacuation. It consists of the immediate sorting of patients according to type and seriousness of injury, and likelihood of survival, and the establishment of priority for treatment and evacuation to assure medical care of the greatest benefit to the largest number.” Triage in this sense originated in World War I. Wounded soldiers were classified into one of three groups: those who could be expected to live without medical care; those who would likely die even with care; and those who could survive if they received care.
Triage scenarios in medical facilities thus represent a wide variety of areas, from emergency room simulations where multiple “patients” need not be tied to a common triggering event, to multiple victim accidents (such as traffic or large scale industrial), to natural disasters and terrorist attacks. The triage scenarios are sometimes called mass casualty simulations. As a representative example, the Asian Disaster Preparedness Center conducted a Mass Casualty Management Simulation Exercise in the Udonthani Province in June 2006 simulating a traffic accident with a bus and a truck.
The advantages of simulators in such mass casualties scenarios have been seen, but the costs of such manikins prevent wide scale adoption for many triage applications. For example, at the time of filing the priority parent application Rush University Medical Center and John H. Stroger Hospital of Cook County Illinois had proposed a simulated mass casualty incident, presumably for October 2009, which was to be representative of a blast from conventional explosives with 12 victims (6 months to 60 years of age). Participants were intended to be physicians and nurses, divided into five medical teams. Victims were to be represented by life sized mannequins, each sustaining a unique pattern of injuries. Various outcomes were to be programmed, from successful resuscitation to death, as follows: 2 to survive without intervention (delayed), 2 to die regardless of intervention (expectant), and the outcome of 8 depended on time sensitive intervention (immediate). The participants were intended to be responsible for division of labor, triage, and medical management. The exercise was expected to involve limited resources such as ventilators, blood and imaging capability. Medical team performance was to be observed and recorded. At the time of filing this application the applicant's had no further information on this proposed simulation.
In a related discussion, an April 2009 article in Pre-hospital Emergency Care by Dale Vincent, et al discusses the teaching of mass casualty triage skills using iterative multi-manikin simulations. See also Kobayashi L, Shapiro M J, Gutman D C, Jay G. “Multiple encounter simulation for high-acuity multi-patient environment training”, Acad Emerg Med. 2007; 14:1141-8. These articles are incorporated herein by reference.
The manikin use in such multiple victim scenarios have provided a number of recorded session data streams which must be evaluated individually to determine the session result. This requires an overall coordination of the results to fully evaluate the session which can become impractical. Further, the costs of each manikin and its associated recording system will limit the broader application of this technique.
With regard to wider simulations, as an example of a large-scale drill was the use of 130 actor-patients in a mass casualty incident disaster exercise in New York City as discussed in Schenker J D, Goldstein S, Braun J, et al. Triage accuracy at a multiple casualty incident disaster drill: the Emergency Medical Service, Fire Department of New York City Experience. J Burn Care Res. 2006; 27:570-5.
There remains a need in the industry to provide an efficient system to integrate multiple medical simulator data and other relevant inputs in real time. There remains a need in the industry to provide an efficient system that can expand manikin use to large mass casualty applications, triage applications, and other multi-simulator applications. There is a further need to address the deficiencies of the prior art in a cost effective manner.